Regional graduate medical education (GME) consortia are a strategy to align public support for GME with societal goals. One such consortium was established in Buffalo, NY, to pool financial resources, facilitate processing of Accreditation Council for Graduate Medical Education requirements, guarantee quality education, and more appropriately use community resources. Cooperation has attracted external funding from state and federal governments and private foundations, fostering community-wide undergraduate medical education, as well as GME. The American Association of Medical Colleges has identified 36 GME consortia in the United States. New York may lead the nation on a strategy to use consortia for the distribution of all state-appropriated GME support. The relationships fostered by consortial interactions have benefitted family medicine and provided opportunities for leading regional medical education into a primary care-specialty balanced future.

Background and Objectives: Current trends in health care demand expanded competencies for future physicians, including group process skills that traditional medical curricula rarely address. One approach to enhancing group dynamics and teaching teamwork skills is outdoor-based experiential learning. This study examines the effect of an outdoor-based learning intervention on family practice interns' group problem solving, team building, and communication.

Methods: Two of 13 programs in the University of Washington Family Practice Residency Network included structured, outdoor-based experiential leadership training during intern orientation. The other 11 programs served as controls. Within 1 month following orientation, surveys were sent to all University of Washington Network interns. Respondents completed 27 questions designed to assess perceptions of trust, group awareness, group problem solving, group effectiveness, and interpersonal communication within an intern class.

Results: The survey response rate was 85%. Study and control groups were not significantly different with respect to age or gender. The study group scored higher on all individual questions and variables, with statistically significant differences on 10 questions and three variables.

Conclusions: Experiential, outdoor-based leadership training may positively influence intern class group formation and development. Experiential training early in residency may reduce intern stress by accelerating intra-class relationships and may represent a foundation on which to build effective group process curricula for residents.

Background and Objectives: Family medicine clerkships compete with other clinical experiences for a limited amount of available curricular time. The overlap of clinical material covered by other departments raises the possibility that students will realize increased or diminished added value from a family practice rotation if they take it later in the third-year schedule.

Methods: All students (n=420) in a required third-year clerkship in two geographically distant medical schools completed pre- and post-clerkship multiple choice examinations on the clinical content of family practice. School A has a lock-step schedule; all the clinical rotations are taken in a specific order by all students. School B has a random schedule. These examinations were random samples, stratified by clinical subject area, from the Exam3Kit database, based on the text Essentials of Family Medicine, Second Edition. The difference between the pre- and post-clerkship scores determined the incremental performance.

Results: There was no significant change in incremental performance over the course of the year at either school.

Conclusions: The increased fund of knowledge acquired during a family medicine clerkship, as measured by a multiple choice examination, is not diminished by prior clinical clerkships in other specialties.

Background and Objectives: The educational efficacy of family practice residency behavioral science training and how various educational approaches might influence graduate practice activity are poorly understood. In this study, we compare a traditional didactic and clinical block rotation approach to a problem-based learning (PBL) and clinical, experiential behavioral science curriculum.

Methods: Surveys of pre- and post-intervention cohorts were used to assess graduatesÍ perceptions of their understanding of broad behavioral science concepts, their competence to manage specific behavioral conditions, and their behavioral science practice activity. The two cohorts were University of California, Irvine family practice residency program graduates from 1984-1988 (58) and residency graduates from 1993-1995 (27). American Board of Family Practice (ABFP) In-service Training Examination scores were also compared.

Results: No significant differences were detected in self-perceived competence and ABFP examination performance. Residency graduates in the post-intervention cohort more often included depression, marital counseling, and eating disorders in their practice and reported more frequent practice activity for situational stress and sexual dysfunction. The post-intervention group reported less involvement with alcohol and substance abuse problems. This group also reported practice activity that exceeded perceived levels of competence for attention deficit disorder, learning disorders, and eating disorders.

Conclusions: Participants in a PBL-clinical experiential curriculum reported higher levels of practice activity for several common behavioral problems. It seems unlikely that these differences were due to curriculum changes. Further investigation of the influence of educational and other factors on residency graduate practice activity is needed.

Background and Objectives: Little is known about the reading habits of family practice residents. This study describes the reading practices of family practice residents, including how much time they spend reading and what information sources they use, identifies factors that may be used by educators to stimulate resident reading, and identifies factors that may inhibit or discourage reading.

Methods: A questionnaire about reading habits was mailed to 613 randomly selected resident members of the American Academy of Family Physicians in March 1994.

Results: Of 613 questionnaires sent, 314 (51%) were completed and returned. Participants reported reading an average of 3.7 hours per week and were most often motivated to read to obtain information related to clinical cases or to prepare for an upcoming presentation. Pocket manuals were the most frequently read and original scientific research the least frequently read sources of medical information. Fatigue and family responsibilities were the factors most important in preventing reading. Year in residency, moonlighting hours, age, gender, or household size were not associated with reported reading time.

Conclusions: Clinical cases and upcoming presentations may be the best motivators of resident reading. Training programs need to continue to develop strategies to minimize resident fatigue, which may lead to increased reading among trainees. The importance of original scientific research articles during residency training is unclear.

Background and Objectives: Although national surveys indicate that approximately 2 million women are victims of severe physical aggression by their partners each year, these women are underidentified by physicians. The assessment by medical personnel of partner abuse is hampered by lack of a simple and reliable instrument that systematically and quickly determines the occurrence and effect of abuse among patients.

Methods: Ninety (58% of an eligible pool) consecutive, consenting, eligible female patients at a suburban family practice clinic at a tertiary university hospital completed the Partner Abuse Interview to evaluate the 1-year prevalence and effect of abuse.

Results: The Partner Abuse Interview required as little as 3 minutes to administer. Results obtained with the interview instrument were internally consistent. Interrater reliability was high for the diagnosis of partner relationship problems with physical abuse by males, as reported by females. Approximately 15% of the women reported having sustained injury or being fearful of their partners as a result of their partners' physical aggression in the past year.

Conclusions: The Partner Abuse Interview is a simple and reliable instrument that could be adapted for use by medical personnel to assess incidents of abuse among patients.

Background and Objectives: This study provides information from a national sample of behavioral scientists about their practices and opinions about placement of mental health notes in the general medical record.

Methods: Using a mailed survey, behavioral scientists in US family practice residencies responded to questions about the location of mental health notes, the rationale for placement of notes, and opinions about integration of mental health notes into general medical records.

Results: The majority (71.8%) of behavioral scientists record mental health notes in the main body of the patient's medical chart, integrated with physician notes. Most respondents favor an integrated record to increase collaboration with medical providers. A variety of methods are used to minimize the chance of violating patient confidentiality.

Conclusions: Although a majority of behavioral scientists integrate mental health notes in the medical chart and favor the practice of doing so, there is no consensus about this practice as reflected by divergent views and record-keeping methods.

Background and Objectives: Focus group interviews have been used extensively in health services program planning, health education, and curriculum planning. However, with the exception of a few reports describing the use of focus groups for a basic science course evaluation and a clerkshipÍs impact on medical students, the potential of focus groups as a tool for curriculum evaluation has not been explored. Focus groups are a valid stand-alone evaluation process, but they are most often used in combination with other quantitative and qualitative methods. Focus groups rely heavily on group interaction, combining elements of individual interviews and participant observation. This article compares the focus group interview with both quantitative and qualitative methods; discusses when to use focus group interviews; outlines a protocol for conducting focus groups, including a comparison of various styles of qualitative data analysis; and offers a case study, in which focus groups evaluated the effectiveness of a pilot preclinical curriculum.

Background and Objectives: This survey examined how time is allotted for family medicine faculty to pursue scholarly activities and how these activities are rewarded.

Methods: A survey was sent to all directors of family practice residency programs (n=373) and chairs of family medicine departments (n=112). Four primary questions were asked: 1) How is faculty time allotted for scholarly activities? 2) Does the residency or department use an explicit reward system? 3) What activities are rewarded? and 4) What rewards are used?

Results: A total of 363 surveys were returned, for a response rate of 75%. Forty-nine percent of respondents have regular, protected faculty time for scholarly activities. Faculty at university-based residencies and departments were more likely to have protected time (68/93, 73%) than faculty at community-based residencies (93/238, 39%). Thirty-eight percent of respondents have an explicit reward system. Activities rewarded and rewards used are department and program-type specific.

Conclusions: Only 39% of community-based residencies and 73% of university programs allot regular protected time for faculty. The majority of programs and departments do not have an explicit reward system. Further studies are needed to determine if the use of protected time and reward systems enhance scholarly productivity.